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Caldas da Rainha, Portugal

Sousa L.,University of Coimbra | de Sa J.,Centro Hospitalar Lisbon Norte | de Sa J.,Centro Hospitalar Of Lisbon Central | Sa M.J.,Centro Hospitalar Sao Joao | And 23 more authors.
Revista de Neurologia

Patients and methods: Clinical data for adult patients with RRMS treated with natalizumab at specialist neurology centres in Portugal were entered retrospectively into a database for analysis between October 2010 and February 2012. Changes in annualized relapse rates (ARR), Expanded Disability Status Scale (EDSS) scores and disability status were analysed.Results: A total of 383 patients from 20 centres were included. Prior to starting natalizumab, the baseline median EDSS score was 4 and the mean ARR was 1.64. Most patients had previously received multiple sclerosis treatment (93.0%). Median natalizumab treatment duration was 12 months. Natalizumab treatment was associated with significant (p < 0.001) reductions from baseline in the mean ARR and EDSS scores in patients treated with natalizumab for ≥ 12 months (n = 288) and for ≥ 24 months (n = 160). Natalizumab was more effective in patients with less disability (EDSS < 3) and in those who had not previously received disease-modifying treatments. Two cases of progressive multifocal leukoencephalopathy were reported. No new unexpected adverse events occurred.Conclusion: Natalizumab is well tolerated, and is effective in reducing relapse rate and stabilising disease in patients with RRMS in the clinical practice setting in Portugal. Its efficacy persists with continued treatment, and it may be particularly effective in patients with less disability and without prior disease modifying therapy.Introduction: Studies have shown that natalizumab is an effective treatment for relapsing-remitting multiple sclerosis (RRMS). To date, no data are available in Portuguese patients.Aim: To determine the efficacy and safety of natalizumab in patients with RRMS in routine clinical practice in Portugal. © 2014 Revista de Neurología. Source

Fonseca J.,Hospital Garcia de Orta | Alves C.C.,Centro Hospitalar da Cova da Beira | Neto R.,Centro Hospitalar Do Funchal | Arroja B.,Hospital de Santo Andre | And 11 more authors.
Gastroenterologia y Hepatologia

Background: Nonvariceal upper gastrointestinal bleeding (NVUGIB) is associated with important mortality. More information is needed in order to improve NVUGIB management. The aims of this study were: (a) characterizing Portuguese patients and clinical approaches used in NVUGIB, (b) comparing management used in Portugal with management globally used in European countries, (c) identify factors associated with management options, and (d) identify factors associated with adverse outcome. Methods: ENERGiB was an observational, retrospective cohort study, on NVUGIB with endoscopic evaluation, carried across Europe. This study focuses on Portuguese patients of the ENERGiB study. Patients were managed according to routine care. Later, data were collected from files. Multivariate/univariate analyses were conducted on predictive factors of poor outcome and clinical decisions. Results: Patients (n=404) were mostly men (66.8%), mean age 68, with co-morbidities (72%), frequently on NSAIDs/aspirin. Most were assisted by general medical (57.8%) or surgical team (20.6%), only 19.4% by gastroenterology/GI-bleeding team. PPI was largely used. Gastric/duodenal ulcers, erosive gastritis and esophagitis were the main bleeding causes. 10% had bleeding persistence/recurrence. Death occurred in 24 patients, 20 from a non-bleeding related cause. Poor outcomes were related with age >65, co-morbidities, fresh blood haematemesis, shock/syncope, bleeding through previous nasogastric tube, massive fluid replacement or transfusions besides erythrocytes. Conclusions: This study contributed to characterization of Portuguese patients and NVUGIB episodes in real clinical setting and identified factors associated with a poor outcome. It also identified differences, especially in the organization of GI bleeding teams, which might help us to improve the management of these patients. © 2011 Elsevier España, S.L. and AEEH y AEG. Source

Melo Gomes J.A.,Instituto Portugues Of Reumatologia Responsavel Pela Consulta Of Reumatologia Infantil | Gomes S.M.,Centro Hospitalar das Caldas da Rainha | Conde M.,Hospitalar de Pediatria
Acta Reumatologica Portuguesa

Autoinflammatory syndromes (AIS) are a heterogeneous group of congenital diseases characterized by the presence of recurrent episodes of fever and local or generalized inflammation, in the absence of infectious agents, detectable auto-antibodies or antigen-specific autoreactive T-cells. These diseases have been much better understood during the past 15 years, mainly due to the marked advances of the Human Genoma Project and its implications in the identification and characterization of genetic mutations. In this paper we make a revision of the classification of AIS and focus our attention specially on the cryopyrin-associated periodic syndromes (CAPS), in particular the CINCA syndrome that shares many clinical characteristics with juvenile idiopathic arthritis. Source

Marques J.M.,University of Lisbon | Eggenkamp H.G.M.,University of Lisbon | Graca H.,Centro Hospitalar das Caldas da Rainha | Carreira P.M.,Technological and Nuclear Institute of Portugal | And 3 more authors.
Isotopes in Environmental and Health Studies

We conducted chemical and isotopic analyses to develop and test a hydrogeological model of thermomineral water circulation in a limestone aquifer system at Caldas da Rainha(Central Portugal),contributing to future borehole-drilling and development strategies, with the aim of extracting waters with the best possible flow and/or temperature. The thermomineral waters (T ≈ 33°C) discharge from springs and boreholes located close to a locally N-S-oriented oblique fault (60°E) that places loamy and detritic Upper Jurassic rocks and Hettangian-Rhaetian marls (and evaporitic deposits) in contact. 14C determinations indicate a pmC content between 29.33 ± 0.14 and 44.39 ± 0.20 pmC. The presence of HCO3 -, Ca2+ (and Mg2+) are ascribed to water-limestone interactions, while Na+, Cl- and SO4 2- concentrations are mainly associated with the dissolution of halite and gypsum lenses found along the regional syncline structure. The δ18O values of Caldas da Rainha thermomineral water were slightly lower than those of shallow groundwater from the Upper Jurassic rocks, suggesting the existence of two distinct aquifer systems. The different isotopic composition of water also indicates that the main recharge of the thermomineral waters likely occurs in the Middle and Lower Jurassic limestone formations of the Candeeiros Mountains. The presence of 3H (from 1.1 to 2.8 TU) in some thermomineral borehole waters (showing rather similar geochemical signatures) suggests mixing of small amounts of shallow groundwater with thermomineral waters, as a result of leaking borehole casing construction or a recharge when the 3H content in the atmosphere was higher than that at present. Caldas da Rainha thermomineral waters having δ34Ssulphate and δ18Osulphate values between +14.9 and +19.1‰ and +11.1 and +16.2‰, respectively, indicate that the sulphate is the result of water-rock interaction with evaporitic formations. The obtained chemical and isotopic data have informed the further development of a hydrogeological model that will be used by decision-makers, in order to contribute to the socio-economic development of the spa region. © 2010 Taylor & Francis. Source

Pimentel-Santos F.M.,New University of Lisbon | Pimentel-Santos F.M.,Centro Hospitalar Lisbon Ocidental CHLO | Matos M.,New University of Lisbon | Matos M.,University of Tras os Montes e Alto Douro | And 16 more authors.
Tissue Antigens

Human leukocyte antigen (HLA)-B27 is the mostly known major histocompatibility complex (MHC) gene associated with ankylosing spondylitis (AS). Nonetheless, there is substantial evidence that other MHC genes appear to be associated with the disease, although it has not yet been established whether these associations are driven by direct associations or by linkage disequilibrium (LD) mechanisms. We aimed to investigate the contributions of HLA class I and II alleles and B27-haplotypes for AS in a case-control study. A total of 188 HLA-B27 AS cases and 189 HLA-B27 healthy controls were selected and typed for HLA class I and II by the Luminex polymerase chain reaction-sequence specific oligonucleotide probe (PCR-SSOP) method. Allelic and haplotypic distributions were estimated by maximum likelihood method using Arlequin v3.11 and statistical analysis were performed by Stata10.1. No associations were found between non-HLA-B27 loci and AS susceptibility, but several associations were observed for phenotypic features of the disease. DRB1*08 was identified as a risk factor for uveitis and DQB1*04 seems to provide protection for AS severity (functional, metrological and radiological indexes). A*02/B27/C*02/DRB1*01/DQB1*05 [P<0.0001; odds ratio (OR)=39.06; 95% confidence interval (CI) (2.34-651)] is the only haplotype that seems to confer susceptibility to AS. Moreover, the haplotype A*02/B27/C*01/DRB1*08/DQB1*04 seems to provide protection for disease functional and radiological repercussions. Our findings are compatible with the hypothesis that other genes within the HLA region besides HLA-B27 might play some role in AS susceptibility and severity. © 2013 John Wiley & Sons A/S. Source

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